RESUMEN
To compare the results of transthoracic contrast echocardiography (TTCE) adding a grading scale with the results of thoracic computed tomography (CT) in order to optimise the use of both techniques. 95 patients with hereditary haemorrhagic telangiectasia (HHT) were examined with TTCE and thoracic CT to detect pulmonary arteriovenous malformations (PAVMs). According to previous studies, TTCE was divided into a four grade scale depending on the degree of opacification of the left ventricle after the administration of a contrast agent. Of the 95 patients (50.5% female; mean age 46 yrs), none with normal or grade 1 TTCE had detectable PAVMs on thoracic CT. Shunts of grades 2, 3 and 4 were associated with PAVMs according to thoracic CT in 25, 80, and 100% of the cases. There was a statistically significant association between the TTCE grade and the detection of a PAVM by thoracic CT. There were also statistically significant associations between TTCE grade and the cardiac cycle when the contrast was first visible in the left atrium, and size of the feeding artery. Graded TTCE and timing of left atrium opacification may be useful techniques in selecting HHT patients for PAVM screening with thoracic CT scans.
Asunto(s)
Malformaciones Arteriovenosas/diagnóstico por imagen , Ecocardiografía/métodos , Circulación Pulmonar , Telangiectasia Hemorrágica Hereditaria/diagnóstico por imagen , Adolescente , Adulto , Anciano , Angiografía , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
The clinical features of seven patients with persistent hiccup are reported. Hiccup did not respond to the usual therapies and resolved with baclofen. The administration guidelines and secondary effects are discussed. The authors suggest baclofen should be considered the drug of choice for treating persistent hiccup.
Asunto(s)
Baclofeno/uso terapéutico , Hipo/tratamiento farmacológico , Relajantes Musculares Centrales/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Cerebral toxoplasmosis is optimally treated with the combination of high doses of sulphadiazine and pyrimethamine. We described two patients with AIDS treated for cerebral toxoplasmosis who developed renal failure due to sulphadiazine-induced crystalluria. Symptoms and renal failure were rapidly reversed with urine alkalinization and hydration. A careful monitoring and adequate hydration of patients with AIDS treated with high doses of sulphadiazine appears mandatory to avoid this complication.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Lesión Renal Aguda/inducido químicamente , Sulfadiazina/efectos adversos , Toxoplasmosis Cerebral/tratamiento farmacológico , Infecciones Oportunistas Relacionadas con el SIDA/parasitología , Adulto , Cristalización , Humanos , Masculino , Sulfadiazina/uso terapéuticoRESUMEN
Erythromycin is commonly used for the empirical treatment of community-acquired pneumonia, but there is some concern about its usefulness when Q fever is suspected because of in-vitro studies showing a lack of efficacy against Coxiella burnetii. This study was undertaken to assess the clinical value of the antibiotic in this setting. Nineteen patients with Q fever pneumonia treated with a variety of antibiotics considered ineffective against C. burnetii, were reviewed. Eleven patients who received erythromycin had a rapid clinical improvement and each became afebrile by the fourth day of treatment. However, only two of eight patients who received other antibiotics improved (both of them had been treated with beta-lactams). Both groups were comparable regarding to age and previous duration and severity of disease. Those patients who did not respond to other antibiotics improved promptly after erythromycin was started. This study suggests that erythromycin is an adequate treatment for Q fever pneumonia.